Depression From Loss Of A Loved One

Can Grief Morph Into Depression

• Joseph Nowinski, PhD, Contributor

Last week, NPRs “Talk of the Nation” aired a show that explored the line between grief and depression. Although they are quite different, they look surprisingly alike. Panelist Dr. Michael Miller, editor of the Harvard Mental Health Letter and assistant professor of psychiatry at Harvard Medical School, said that with both grief and depression “People cry. They feel depressed. Theyre having trouble sleeping. They may not have an appetite. They may not feel like doing anything. They may not take pleasure in anything.”

For years, the American Psychiatric Association has urged doctors not to diagnose major depression in individuals who have recently lost a loved one. In the Diagnostic and Statistical Manual of Mental Disorders, sometimes known as the psychiatrists bible for diagnosing mental illness, grief is specifically listed as an exception to the diagnosis of clinical depression. The organization is now considering dropping that exclusion, raising the question: Is grieving ever pathological?

Path To Improved Well Being

There is no right way to grieve. Everyone is different. Give yourself time to experience your loss in your own way. At the same time, remember to take care of yourself.

There is no set timetable for grief. You may start to feel better in 6 to 8 weeks, but the whole process can last anywhere from 6 months to 4 years. You may start to feel better in small ways. It will start to get a little easier to get up in the morning, or maybe youll have more energy. This is the time when youll begin to reorganize your life around your loss or without your loved one. During this time, it may feel like you go through a series of ups and downs. You may feel better one day, but worse the next. This is normal.

Over time, youll begin to find interest in other people and activities again. If youve lost a loved one, its normal to feel guilty or disloyal to them during this time. Its also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays, or other special occasions.

Final Thoughts On Grief Vs Depression

The outlook for those suffering from grief and/or depression continues to be positive. Uncomplicated grief tends to begin to resolve naturally, without any form of professional intervention, within 6 months post-loss. Those experiencing complicated grief or PCBD, with or without depression, will likely benefit from individual or group therapy, and a medical assessment.

Grief can be initially expected to be intense and to negatively impact ones ability to function in daily life. This is a natural response to a major loss. However, if improvement in functioning and some reduction in the intensity of emotional distress is not happening within 6 months after the loss, a professional should be consulted. Also, if one is experiencing suicidal thoughts and impulses, it is important to seek professional help immediately.

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Grieving: Facing Illness Death And Other Losses

Grief is a persons normal, healthy response to a loss. It describes the emotions you feel when you lose someone or something important to you. People grieve for many different reasons, including:

• Death of a loved one, including pets.
• Divorce or changes in a relationship, including friendships.
• Changes in your health or the health of a loved one.
• Losing a job or changes in financial security.
• Changes in your way of life, such as during retirement or when moving to a new place.

The loss that triggers grief isnt always physical. You can experience grief if you or a loved one are diagnosed with a major disease or face a serious illness. You may grieve the future plans you had made, or the ways life will change.

Grief is different for everyone. It can include many emotional and physical symptoms, including:

• Feelings: Anger, anxiety, blame, confusion, denial, depression, fear, guilt, irritability, loneliness, numbness, relief, sadness, shock, or yearning.
• Thoughts: Confusion, difficulty concentrating, disbelief, hallucinations, or preoccupation with what was lost.
• Physical sensations: Dizziness, fast heartbeat, fatigue, headaches, hyperventilating, nausea or upset stomach, shortness of breath, tightness or heaviness in the throat or chest, or weight loss or gain.
• Behaviors: Crying spells, excessive activity, irritability or aggression, loss of energy, loss of interest in enjoyable activities, restlessness, or trouble sleeping.

Seeking Support For Grief And Loss

The pain of grief can often cause you to want to withdraw from others and retreat into your shell. But having the face-to-face support of other people is vital to healing from loss. Even if youre not comfortable talking about your feelings under normal circumstances, its important to express them when youre grieving.

While sharing your loss can make the burden of grief easier to carry, that doesnt mean that every time you interact with friends and family, you need to talk about your loss. Comfort can also come from just being around others who care about you. The key is not to isolate yourself.

Turn to friends and family members. Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Rather than avoiding them, draw friends and loved ones close, spend time together face to face, and accept the assistance thats offered. Often, people want to help but dont know how, so tell them what you needwhether its a shoulder to cry on, a listening ear, or just someone to hang out with. If you dont feel you have anyone you can regularly connect with in person, its never too late to build new friendships.

Join a support group. Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers, or see the links below.

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Loss Of Identity In Familial Relationships

One of the biggest struggles for your grief and depression journey is the unexpected loss of a relationship. The loss of your identity as a father, a mother, a husband, or a wife can be a traumatic experience that can further your bereavement process. The feeling of loss can catch you off guard as you navigate new roles that are thrown at your because of losing that family member. For example, you may find yourself taking over both the parts of a father and a mother if you lose your spouse. Or, you may have to become a primary caretaker for your aging father after your mother passes away. This different relational sense of self can have you questioning whether you can fulfill new roles and who you indeed are in your network and community.

Read: Self-Care When Grieving

Your grief and depression counselors can help you identify and learn to cope and embrace new roles in your life. The journey will not be smooth sailing, nor is it predictable enough for you to plan for, but you can rest assured that the process of recovery will be supported. Your healing process will be filled with triumphs through the guidance of an expert in dealing with loss.

What Distinguishes Prolonged Grief Disorder From Depression

Pål Kristensen specialist in psychology and dr. philos. He has contributed to the idea, literature review, interpretation of data and revision of the manuscript.

The author has completed the ICMJE form and declares no conflicts of interest.

Kari Dyregrov professor dr. philos. She has contributed to the interpretation of data, preparation/revision of the manuscript and has approved the submitted manuscript version.

The author has completed the ICMJE form and declares no conflicts of interest.

Center for Crisis Psychology, Bergen, Norway

Faculty of Health and Social Sciences

Bergen University College, Norway

Atle Dyregrov specialist in psychology and professor dr. philos. He has contributed to the interpretation of the data, preparation/revision of the manuscript and has approved the submitted manuscript version.

The author has completed the ICMJE form and declares no conflicts of interest.

Center for Crisis Psychology, Bergen, Norway

Prolonged grief disorder, which is proposed as a new diagnosis in ICD-11, and depression share some similarities but also several key differences. In order to provide the correct help and treatment, it is important for doctors to be able to ascertain whether a person is struggling with prolonged grief or has become depressed following the loss of a loved one

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When Should I Seek Help For My Grief

If you are experiencing persistent feelings of sadness and despair, and are unable to experience happiness, you may be experiencing the symptoms of depression. If your feelings are getting in the way of your everyday life, then its important to seek help.

Signs that you may need to seek help include:

• appetite changes
• intense sadness
• feelings of emptiness feelings of despair
• thoughts of harming yourself

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Core Concepts: Grief And Depression

Grief can be described by therapists in a few different ways depending upon the type of symptoms presenting, how long they have lasted, and how debilitating they are to the individual.

The three most commonly used terms to describe grief are:

• Uncomplicated Grief
• Persistent Complex Bereavement Disorder

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How Can People Cope With Grief

There remains some controversy about how to best help people survive the loss of a loved one. While many forms of support are available and do help certain individuals, little scientific research has shown clear benefits for any particular approach for grief reactions in general. That is thought to be because each approach to support is so different that it is hard to scientifically compare one to another, intervention procedures are not consistently reported in publications, and the ways these interventions have been studied are flawed. Although there has been some concern that grief counseling for uncomplicated grief sufferers works against bereavement recovery, there is research to the contrary.

• One approach to treating grief is the dual-process model, which endorses the bereavement process as being the dynamic struggle between the pain of the death of the loved one and recovery .
• This model of treatment recommends that bereaved individuals alternate between directly working on their loss and taking a break from that process when appropriate.
• For couples who are grieving the occurrence of a miscarriage, brief professional counseling is helpful.

Quite valuable tips for journaling as an effective way of managing bereavement rather than just stirring up painful feelings are provided by the Center for Journal Therapy. While encouraging those who choose to write a journal to apply no strict rules to the process, some of the ideas encouraged include

Alcohol Tobacco And Other Drugs

Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSAs 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.

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How To Help When Friend Or Family Member Is Depressed

The inability to sleep is called insomnia, and if someone in your family starts complaining about insomnia, watch for other signs of depression. Sometimes it is helpful to make a comparison to a physical illness. For example, many people get sick with a cold or the flu, but only a few get really sick with something serious like pneumonia. People who have a cold are usually able to do their normal activities. However, if they get pneumonia, they will have to take medicine and may have to go to the hospital.

• You can help them to cope with depression symptoms, overcome negative thoughts, and regain their energy, optimism, and enjoyment of life.
• You may find it helpful to consider family therapy as an option.
• Thats why you have to help out your friend to build their support network!
• With the right treatment approach, the person you care about can get better.
• A person with depression often needs treatment to see improvement and thats something only a medical professional can provide.

Persistent Complex Bereavement Disorder

PCBD is a psychiatric diagnosis that is made when a person has become stuck in their grieving process for a period of at least 12 months since the death of the loved one

This diagnosis would be appropriate in situations in which an individual is:7

• Suffering from intensely distressing grief, related to the death of a loved one
• Experiencing difficulties in functioning in one or more areas of their life

PCBD has been found to occur in approximately 2-5% of individuals who are suffering from grief.7

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Grief Vs Depression: Similarities & Differences

Uncomplicated grief and depression share some similarities in symptoms which can often lead to confusion about whether one is dealing with grief, depression, or both.

Symptoms which are shared by both include:6,17

• Low mood
• Sadness

When Grief Triggers Depression

Significant stressors can be the trigger for the onset of mental illness. Thus, a major loss in ones life that causes grief, in some individuals, will also lead to the development of clinical depression. It is thus important to be able to tell grief and depression apart, and to know what symptoms indicate the need for professional support.

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Handling Grief & Depression During The Happiest Time Of The Year

The holidays are celebrated as a time for joy and togetherness, but they arent happy for everyone. When you or someone you love is struggling with loss, depression, or illness, the holiday season can be painful to navigate.

Our emotional pain affects each of us differently. Whatever issue were dealing withdivorce, sickness, job loss, a death in the familythe holidays are uniquely challenging when were struggling. Because they are full of company, traditions, and events, the holidays can trigger and heighten feelings of loss or depression.

But feeling sad, mad, or empty isnt always a bad thing. Our help patients learn how to process these feelings in a healthy way when the holidays become too much.

Try these 10 strategies to help you, or someone you love, through a difficult holiday:

Recognize that grief and depression are very personal and very complex. Dont be disheartened if you cant just snap out of it despite the festivities. When these negative feelings strike, ask yourself what you need. Do you want to be alone to process your feelings? Would you prefer some company from friends and family? Do you need a positive distraction? Make whichever decision is best for you.

Focus on good health. Dont use drugs or alcohol to numb your feelings. Get plenty of rest, eat a nutritious diet, and make time for exercise. Not only will it help you feel better by boosting serotonin, it also helps prevent holiday weight gain and mitigates stress.

Celebrate Your Loved Ones Life

Rituals such as a funeral or memorial service can fulfill important functions, allowing you to acknowledge and reflect on the persons passing, remember their life, and say goodbye. In the period after a funeral, however, your grief can often become even more intense. Often, other people may appear to have moved on, while youre left struggling to make sense of your new normal.

Remembering your loved one doesnt have to end with the funeral, though. Finding ways of celebrating the person you loved can help maintain their memory and provide comfort as you move through the grieving process.

Keep a journal or write a letter to your loved one. Saying the things you never got to say to your loved one in life can provide an important emotional release and help you make sense of what youre feeling.

Create a memorial. Building a memorial to your loved one, creating a website or blog, or compiling a photo album or scrapbook to highlight the love you shared can help promote healing. Planting flowers or a tree in your loved ones memory can be particularly rewarding, allowing you to watch something grow and flourish as you tend to it.

Build a legacy. Starting a campaign or fundraiser in your loved ones name, volunteering for a cause that was important to them, or donating to a charity they supported, for example, can help you find meaning in their loss. It can also add a sense of purpose as you move forward with your own life.

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When A Patient Suicides

Mental illness is one of the most robust risk factors for suicide, occurring in > 90% of all suicides. Patient suicide is an occupational hazard for psychiatrists, since psychiatrists treat the most chronically and severely ill patients, utilizing treatments that are not perfect. Studies have found that > 50% of psychiatrists have lost at least one patient to suicide, and many have lost more than one . Thus, it is no surprise that patient suicide has been reported as one of the most frequent and stressful crises experienced by health providers around the world , .

When a psychiatrist loses a patient to suicide, personal reactions are as varied as in other survivors. Low mood, poor sleep and irritability, for example, have been described . Many studies have found high rates of problematic grief experiences in survivors, such as intense guilt or feelings of responsibility for the death, a ruminative need to explain or make sense of the death, strong feelings of rejection, abandonment and anger at the deceased, trauma symptoms, complicated grief, and shame about the manner of death , . Psychiatrists are not immune to these reactions when they, themselves, become survivors . In addition, fear of litigation and retribution from the psychiatric community can complicate the psychiatrists response .